Email Address
*
Name
*
First Name
Last Name
Gender
*
Male
Female
Year of Birth
*
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
SM & SW
Year of Birth for SM & SW
School the member attends:
Month of Birth
*
January
February
March
April
May
June
July
August
September
October
November
December
Day of Birth
*
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Address
*
Contact Telephone number - Home
*
Contact Telephone number - Mobile
*
Emergency contact name and relationship to the member:
*
Telephone number to contact this person on:
*
Name, address contact number of members GP
*
Medical Information
*
Yes
No
Please provide further information:
Please provide an email address for club and basketballscotland to use to contact the member
*
If you wish other email addresses to be added to the club list, please put it here:
Member Declaration
*
I confirm the information supplied is accurate. I also agree to inform the club immediately should any of the information change, I agree to abide by the Basketball Scotland Code of Conduct and the clubs rules and policys, I give consent for photos and videos for promotion of the club and the sport and abide by Basketball Scotland Photography Consent Policy, I consent to receiving medical treatment, including anaesthetic, as is deemed necessary by the attending medical personnel. I understand that by signing this registration form I/my child will be considerd bound to the club until completing the release process in place by Basketball Scotland.
Members (or Parent/Guardian) Signature
Please state your name as the person responsible for reading this membership application and accepting terms
Signature Acceptance
*
Please check the box to confirm you have read the statements and are the person listed in the Members (or Parent/Guardian) Signature Box and agree to signing the membership application online
